Cardiac magnetic resonance (CMR) was initially performed 2-6 days after study medication and again at 12 weeks.

Concomitant Medications:

At baseline in the epoetin alfa group, the use of aspirin was 89%, clopidogrel 96%, heparin 88%, and glycoprotein IIb/IIIa inhibitor 72%.

Principal Findings:

Overall, 222 STEMI patients were randomized (138 patients in efficacy analysis). In the epoetin alfa group, the mean age was 57 years (16% were ≥70 years), 19% were women, 11% had diabetes, infarct-related artery was the nonanterior location in 72%, and mean blood pressure was 130/78 mm Hg.

The primary outcome, infarct size (as a percentage of left ventricular mass) at first CMR was 15.8% in the epoetin alfa group versus 15.0% in the placebo group (p = 0.67). Among patients ≥70 years old, infarct size was 19.9% versus 11.7% (p = 0.03). At the second CMR, infarct size was 10.6% versus 10.4% (p = 0.89), respectively.

Interpretation:

Among patients with STEMI who underwent reperfusion by PCI, the use of intravenous epoetin alfa was not beneficial. This medication did not reduce infarct size on either the initial CMR or a later CMR performed at 12 weeks. In fact, infarct size was larger in a prespecified cohort of patients ≥70 years old. Clinical outcomes of death, MI, stroke, or stent thrombosis were also more frequent in the epoetin alfa group. The use of erythropoietin should likely be avoided in acute coronary syndromes.